The general lack of useful stuff

I don’t think that shops are quite as useful as they used to be. Take chemist shops for example.  They used to be quite small and generally, sort of, pokey.  They had quite a few weird things in them that you really did not want to look at.  They had a pharmacist who was often a bit weird (maybe), but you got the impression that he knew what he was on about.  You could find all sorts of weird compounds at a chemist, even the raw ingredients for explosive manufacture.

Now we have the mega-super-pharmacy. They feature row after row of nail polish in shades almost, but not completely identical to the bottle adjacent. The rows are in fact nearly all high street cosmetics with 5000 different kinds of moisturisers with a bit of “chemisty stuff” tucked away near the back somewhere. Most of the quirky stuff is gone.  You can’t even buy fabric dye there - this was always a ye olde chemist shop staple. They won’t sell you pseudo-ephedrine (too risky). And as for getting any sensible advice out of the spotty gits that masquaerade as staff, I would forget that completely were I you.

I suppose I shouldn’t be surprised about this.  We have seen the decline of the suburban hardware store, once a place of great diversity and character, now replaced almost completely by that massive temple to consumption, Bunnings.  The biggest concentration of cheaply manufactured, chuck away, chinese crap under one roof in the country I’m sure.  I must make a point of not going there.

It’s all really just a continuation of the supermarket theme I  suppose, but how boring is it?

On the other hand the one thing that has got smaller, cuter and more interesting is the cafe. The only problem being that once your street can support a bohemian little cafe that roasts their own beans, it seems it can support a plethora of said cafes and pretty soon you are awash with latte and not much else.  Douglas Adam’s prediction of the “shoe event horizon” seems to have been realised with respect to coffee rather than footwear.

Complaint about this is incredibly trivial taking into account conditions in most of the world.  Our abundance of crap versus most peoples deficit of anything, although one thing we do have in common is the lack of any useful products.

I suppose some of you may have figured out by now that all I wanted to do today was buy some fabric dye. Any ideas where I can get some?

Drugs, ESBL & Confusion

Well, out of hospital today (yay!). This has to be a good thing.  I’ve returned home with a big bag of drugs and dressings, a dose of  Extended Spectrum Beta-Lactamase (ESBL), and some mild confusion about the hospital system. 

Yes, I hear you say, we understand drugs and confusion, but what is this ESBL you speak of?  Apparently it’s nothing to worry about, although it will get you a private room, which is what I got for the last few days of my stay.  In swabs taken from bits of me last week they detected an enzyme which produce bacteria known to be resistant to various antibiotics such as those based on penicillin. Seemingly, such bacteria have colonised me. They obviously don’t want other patients also becoming colonised and thus I was bundled out of my shared room into a single the minute the result came down.  A good outcome many would say, although there was a sense of shared adventure and understanding in our four person ward.  One funny thing is that all other occupants of my shared room were allergic to penicillin anyway, so I doubt a colonisation would affect them much.  Anyway, I now have the dreaded bugs but have no idea how long for or what to do with them.

Most of my confusion about the hospital system relates to the role of nurses.  In general, the nurses were great and I think good at their jobs.  Some that had to change my dressings, which was a really painful exercise were fantastic.  They managed to do a job that involves hurting someone many times with great compassion, and you knew that they had done their best for you. When I think about the other much more burnt patients that they must have to deal with I can’t imagine how difficult that must be.  I also think that logically most of the really good nursing staff would be assigned to the worse cases.

Despite my overall feeling of satisfaction, I’ve struggled the whole time in hospital to mentally define a nurses job description. I’m sure it is well defined somewhere  Are they there to serve the patients, the doctors, the “system”, or all of the above?  Clearly they are there to take observations at set intervals, bring you your medication on time, and change dressings etc.  But other than that? I had always thought that nurses had a role to “make the patient comfortable” and this still seems to me to be something desirable as comfortable patients are happy and probably heal faster (?).  So many things were done inconsistently.  For example at one point I needed antibiotic cream applied to my face daily. At this point I had barely two operating fingers, movement caused a lot of pain, and no way of getting to a mirror.   Actual scenarios included:

• Nurse A would come in and apply it for me (win!)
• Nurse B would let me know it needed doing and bring the cream to within my reach (I can deal with this is if they are really busy)
• Nurse C would mention it needed doing and leave, and look impatient when I had to buzz her later to find the cream for me.

Unfortunately Nurse B and C popped up a bit too often. When I came to sponge baths (a necessary evil) :

• Nurse A would do it for you and treat you with real dignity.
• Nurse B would get the stuff ready, water in bowls, open sponges and swabs, show you how to clean your burns and leave you to it. This was OK mostly, but sometimes really hard.
• Nurse C would dump the equipment in the bathroom and leave you to try to open plastic packets with scorched fingers.  The pain and frustration involved in sorting this out was sometimes horrendous.

The number of times that nurses failed to put things within your reach that you obviously needed was so significant, that when one did,  it was really noticeable. 

Aside from that I had a lot of issues with my primary pain medication being forgotten, and really defensive attitudes when I’d ask if they should not go back and check.  The doctors were shaking their heads one morning after I had one really painful night which seemed odd, and then the nursing staff admitted that my main long term pain relief had been forgotten which kind of explained my massive appetite for morphine. 

In the end I decided on my own nurse rating system.  I doubt it would fit their true job description but from a patients perspective I think it’s what we need.  It’s simply based on empathy and competence as follows:

It’s quite arbitrary as I freely admit that I can only judge competence up to a basic level.   Nurses may plot anywhere in the system, and I often spent my time working out their position in the matrix.  I had three loose categories as well. There are some Category A nurses around, but not many really.  I so wish that there were more.  Probably the majority are Category B – they’re pretty good but can be fairly frustrating from a patients view point sometimes. 

Lastly there’s our Category C friends, who are  so low on empathy that they are naturally incompetent.  These are the ones that the night after a major operation tell you that you can’t use your Patient Controlled Analgesia (PCA) system because it will interfere with the IV antibiotic.  You point out that they just need to hook the antibiotics up to the OTHER cannula so they are separate and all will be good as it was installed for that reason. They still say they don’t know and disconnect your PCA for nearly an hour (the length of time it takes to find a Category B nurse).  Thank god I’m rid of her.

But, home now and really happy to be and looking forward to catching up with something closer than a normal life over the next few weeks.

Staples.

You know; the things that, back in the day, saw use only to hold sheets of paper together. They were pretty good and practical for this, but a bit spikey and hard to get out sometimes. Then they turned up in furniture. You usually discovered them when the back of your book shelves fell off. I’d usually feel disappointed when this happened, like I’d let myself down by buying junk.

Can anyone guess what doctors use to hold skin grafts in place? I found out the answer to this today when suspended within a big stainless steel vat of 38 degree water having my dressings removed for the first time post-op. Fucking staples. I’d heard mention of removing staples from a nurse or two, and foolishly imagined that this related to securing the complex dressings. It does, but wait, they secure the grafted skin as well. These staples are little shiny items shaped a bit like a ‘5’,which penetrate about 6mm, presumably through energy provided by a staple gun.They are removed with a small manual device not dissimilar to your typical office based staple remover, with a similar success rate to their stationery counterparts. Some come straight out, others jam, twist and straighten - I’m sure you know the drill.

Back to this morning, and with the dressings nearly gone from my arm and leg I’m thinking that this could have been worse for pain. It hurt like hell, but I’m not a quivering, twitching mess. All good. Then I get handed a mouthpiece connected to a massive N2O/oxygen bottle with the suggestion I may wish to take deep breaths through it. This made me suspicious but not wanting to reject such kind offers, I started in on the gas. The first 20 staples were a shock, poking straight through the gas and my usual baseline morphine quite nastily. I then asked how many do they typically use? “It depends on the doctor”.

It seems that, like me, my doctor has little faith in staples, because he used over 500 to secure my graft. I reached quivering, twitching mess status quite fast despite trying to suck the entire gas bottle in. He had even used these 6mm long staples up my fingers where the graft went that high. Ouch!

And then they started tearing off the sheets of dead skin from outside the graft zone just in a fast continuous rip – we won’t go into that but you need holding down for it to work. There is no dignity left in that situation at all.

By the way, I’m not having a go at my doctor in this at all. From what I can see he has done a fantastic job as were the nurses today equally awesome. I just fucking hate staples.

The B.Braun Infusomat Space … this is not a fan page

The background to my life is the B.Braun Infusomat Space.

Queensland Health seemed to have bulk purchased the B.Braun Infusomat space or close relatives as their standard infusion pump system (you know, the boxes that control rate of flow for IV drug infusion etc), at least for Royal Brisbane and some other hospitals. 

Braun says:

“Never before was an infusion pump system as fascinatingly small and light as Braun Infusomat Space. Whether you need a syringe or volumetric pump, a single module or configured unit – you’ll be thrilled with how handy the new format is.
As a pioneer in automated infusion systems, B. Braun has used its know-how to achieve a previously unattainable, ultrahigh level of miniaturization and integration. Designed for both stationary and mobile use, B. Braun Space features a virtually unlimited scope of applications that will redefine all existing standards.
Multiple innovations will make your work noticeably easier. The ergonomic design gives you an instinctive feel for its functionality and convenient handling.
Discover the fascination of B. Braun Space!”

Fascination? Hmmm. I’m not sure how well this device serves its main function relative to competing devices but I am willing to bet that never before has such a small device made such pointless and continuous noises. In a ward of 4 it’s like being surrounded by the retarded children of R2D2. It has an annoying 3 tone alarm, that conveniently plays at 6 second intervals once you are 10 minutes from the end its run, again at the end of the run and sometimes, with shorter runs at 3min from the end.

It has a similarly annoying 3 tone alarm to let you know if there is problem (like someone has moved their cannula, just a tiny bit). If this tone begins, I think all other operation stops. The other aspect to these alarms is that whilst they are quite loud enough to prevent your average patient sleeping if it is their unit or one from an adjacent bed, it is not loud enough for your average nurse to hear from the other side of the ward (particularly given the number always helpfully chirping at once. The alarms cannot be disabled. They can be silenced once started (but obviously not by the likes of us!).

So, a typical scenario for the evening in a typically under-staffed Qld Health ward goes something like this:

• Doctor has prescribed 30 minute antibiotic run with 10 minutes of saline at start and finish at midnight.

• Nurse rocks up, sets up saline and AB, starts first 10 minutes off and then decides to do obs whilst she is there. Half way through taking BP, patient moves cannula too much and alarm on retarded R2D2 goes off. Nurse resets saline run, tells patient to be more careful, and finishes off obs before heading off to answer a call “somewhere”. One minute later, patient is nearly asleep when warning alarm for 3 minutes till end commences. Patient cannot see face of instrument, so after 5 minutes, presses call button.

• 15 minutes minimum later … . yep, that’s generally the minimum for nights … . nurse rocks up and scolds patient for moving too much again (you only moved after you pressed the call button cos you know it does not matter much then). Nurse starts AB flow. Patient lies rigidly and nods off.

• 20 minutes later the 10 minute warning alarm goes off, waking the patient who after waiting an eternity presses the call button, only to find he has managed to lure a nurse who can silence the alarm but cannot do the saline flush. She kills the alarm and says she will ask #1 to come and sort you out.

• She forgets of course, and after 15 min or so you hit the call button again, only to be accused of tampering with the gear, because the alarm is off when #1 arrives. She runs last flush, with the usual moving patient and paging issues. It can take about 2.5 hours to reach this point! This assumes that there is no shift change in the middle. The nurses then often decide that it will be much quicker to just leave all tubes etc attached to you because it’s just 3 hours till the next episode.

BUT, this scenario only considers one Braun Infusomat Space. Your neighbours will have one, generally driven by different nurses. I can hear 4 in the background as I write this in varying states of chirping.

Stupid medical machine is stupid. The nurses hate it, as does every patient.

Gabapentin to the eventual rescue … . .

So, a quick update – please ignore typos etc. Apparently my graft goes from knuckles to elbow, with the skin taken from my right thigh from knee to bum. Came out of the general A. yesterday morning screaming and with what seemed to be total ego loss. Resolved myself as a large black rectangle and a smaller red rectangle, both of which were being excited somehow. I then remember believing I was a very long submarine, with a molten right hand side. I have no idea how long this phase lasted, only that I eventually became ‘me’ in this sea of pain I could not pin point. Kept describing it to the doctors but I don’t think I was making much sense. They had a morphine PCA (Patient Controlled Analgesia) system set up which gives me up to 2.5mg every 5 min. I think I got back to my bed about 1:00 pm and was just hitting the PCA button constantly. It seemed to make no difference at all, and I was in and out of lucidity, yelling a lot and arching on the bed.

I could not get to talk to doctor at all, and the nurses can only do what’s on the sheet and try to page the doctors. By about 3:00 I had fallen into a totally tense, rigid state, afraid to move 1mm, just mentally focused on the pain alone. Even though I realized that this was counter productive, I just could not drag myself out of it. The nurses finally contacted the pain specialist by 3:30 – said he would be there any minute. He rocked up at about 5:00 and figured out quite quickly that the pain was nerve based and so morphine was ineffective. He wrote me up some Gabapentin, which only took another 30 minutes to arrive. This slowly fixed the problem and let the morphine do me some good. All up, about 4 hours of hell I could have done without, but much more under control now. Just need to lie about for 3 days and see if the graft has taken ok.
And thank you all again for the texts and messages of support. I have awesome friends indeed.

Coming soon … …Ian’s rant on the Hospital System, Nurses, and the Braun Infusomat Space (a totally obnoxious piece of kit designed to piss off both nurses and patients alike).

Random and stupid …

So, helping clear up for Earthdance last week I re-learned a lesson the hard way that I had already known all my life. I think most of us were brought up to know that you don’t ever use petrol to get fires going. But with a huge pile of lantana and tobacco weed to get rid of by Saturday it seemed ok as long as we were careful.

I put 4 litres of petrol within the main body of the 5m wide pile (well in from the edges), with one thin stream coming out from a single point to over 5m beyond the edge . It was a still, warm day. I put the remaining petrol out of the way and tidied up a few things. I went back to light the thin stream – it wouldn’t ignite (probably evaporated??). I was in hurry so I then walked around the other side of the pile thinking what I should do? In retrospect I walked into a small depression which extended under the pile. I was a long way from where I had put any petrol and in some stupid brain snap went to light a ball of paper to throw in. My guess is that the vapour had come out along the low point (being heavier than air) at least 8m beyond where I had placed petrol leaving me in the middle of a big bang.

It was a really stupid thing to do – I should have figured that there was vapour everywhere, but was pre-occupied (another fail). But most of all I should not have even contemplated using petrol. Please don’t do it, ever.

I’m typing with 2 fingers on my left hand – most of the others don’t work atm. My face and neck only has 1st degree burns. My arms are the big issue with full circumferential partial/full thickness over most of the right, less extensive to the left. A fair few skin grafts coming up.

Being a doof site it took over an hour to get an ambulance, with me sitting in a creek being doused with water. Not a great pain experience I can assure.

But thinking about this, it would be really easy for that error of judgement to be compounded. If there were kids about, I would have kept them well away, but, far enough?

I’m sure that all here are smart enough not to do this, but if you ever have that thought, that it will be ok if you are careful, just think again.